Halpern John H, Pope Harrison G
Harvard Medical School, Biological Psychiatry Laboratory, Alcohol and Drug Abuse Research Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478-9106, USA.
Drug Alcohol Depend. 2003 Mar 1;69(2):109-19. doi: 10.1016/s0376-8716(02)00306-x.
'Flashbacks' following use of hallucinogenic drugs have been reported for decades; they are recognized in DSM-IV as 'Hallucinogen Persisting Perception Disorder (Flashbacks)', or HPPD. We located and analyzed 20 quantitative studies between 1955 and 2001 examining this phenomenon. However, many of these studies were performed before operational criteria for HPPD were published in DSM-III-R, so they are difficult to interpret in the light of current diagnostic criteria. Overall, current knowledge of HPPD remains very limited. In particular (1) the term 'flashbacks' is defined in so many ways that it is essentially valueless; (2) most studies provide too little information to judge how many cases could meet DSM-IV criteria for HPPD; and consequently (3) information about risk factors for HPPD, possible etiologic mechanisms, and potential treatment modalities must be interpreted with great caution. At present, HPPD appears to be a genuine but uncommon disorder, sometimes persisting for months or years after hallucinogen use and causing substantial morbidity. It is reported most commonly after illicit LSD use, but less commonly with LSD administered in research or treatment settings, or with use of other types of hallucinogens. There are case reports, but no randomized controlled trials, of successful treatment with neuroleptics, anticonvulsants, benzodiazepines, and clonidine. Although it may be difficult to collect large samples of HPPD cases, further studies are critically needed to augment the meager data presently available regarding the prevalence, etiology, and treatment of HPPD.
使用致幻药物后出现“闪回”现象的报告已有数十年；在《精神疾病诊断与统计手册第四版》（DSM-IV）中，它们被认定为“致幻剂持续性感知障碍（闪回）”，即HPPD。我们查找并分析了1955年至2001年间研究这一现象的20项定量研究。然而，这些研究中的许多是在HPPD的操作标准在《精神疾病诊断与统计手册第三版修订本》（DSM-III-R）中公布之前进行的，因此根据当前的诊断标准很难对其进行解读。总体而言，目前对HPPD的了解仍然非常有限。具体而言：（1）“闪回”一词的定义方式繁多，基本上毫无价值；（2）大多数研究提供的信息太少，无法判断有多少病例符合DSM-IV中HPPD的标准；因此（3）关于HPPD的危险因素、可能的病因机制和潜在治疗方式的信息，在解读时必须极其谨慎。目前，HPPD似乎是一种真实但不常见的疾病，有时在使用致幻剂后持续数月或数年，并导致相当程度的发病。最常见的报告是在非法使用麦角酸二乙酰胺（LSD）之后，但在研究或治疗环境中使用LSD，或使用其他类型的致幻剂时则较少见。有使用抗精神病药物、抗惊厥药物、苯二氮䓬类药物和可乐定成功治疗的病例报告，但没有随机对照试验。尽管可能难以收集大量的HPPD病例样本，但迫切需要进一步的研究来补充目前关于HPPD患病率、病因和治疗的稀少数据。
